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CONNECTICUT STATE DEPARTMENT OF EDUCATION

BUREAU OF HEALTH/NUTRITION, FAMILY SERVICES AND ADULT EDUCATION

Application for Funds

YOUTH SERVICE BUREAU GRANT PROGRAMJuly 1, 2015 – June 30, 2017

Purpose: To assist municipalities or private agencies serving youth, which are designated to act as agents for such municipalities, in establishing, maintaining or expanding such Youth Service Bureaus.

Pursuant to Sections 10-19m through 10-19o of the Connecticut General Statutes.

Applications Due: June 15, 2015

Published: May 8, 2015 RFP #120

2015-17 Youth Service Bureau Grant Application

Connecticut State Department of Education

Dianna WentzellCommissioner of Education

The Connecticut State Department of Education is committed to a policy of equal opportunity/affirmative action for all qualified persons. The Connecticut State Department of Education does not discriminate in any employment practice, education program, or educational activity on the basis of race, color, religious creed, sex, age, national origin, ancestry, marital status, sexual orientation, gender identity or expression, disability (including, but not limited to, intellectual disability, past or present history of mental disorder, physical disability or learning disability), genetic information, or any other basis prohibited by Connecticut state and/or federal nondiscrimination laws. The Connecticut State Department of Education does not unlawfully discriminate in employment and licensing against qualified persons with a prior criminal conviction. Inquiries regarding the Connecticut State Department of Education’s nondiscrimination policies should be directed to:

Levy GillespieEqual Employment Opportunity DirectorConnecticut State Department of Education25 Industrial Park RoadMiddletown, CT 06457860-807-2101 [email protected]

THE CONNECTICUT STATE DEPARTMENT OF EDUCATION IS ANAFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER.

mailto:[email protected]


TABLE OF CONTENTS

Purposes and General Information...................................................................................................1Overview..........................................................................................................................................1Who May Apply?.............................................................................................................................2Grant Award Period.........................................................................................................................2Available Funds and Local Match Requirements............................................................................2Required Program Evaluation, Data Collection and Professional Development Activities............2Deadline and Use of Application Form...........................................................................................3Affirmative Action Assurances........................................................................................................3Additional Obligations of Grantee...................................................................................................3Due Dates and Ongoing Reporting..................................................................................................4Freedom of Information Act............................................................................................................4Management Control of the Program and Grant Consultation Role of CSDE Personnel...............4Annie E. Casey Foundation.............................................................................................................4Facsimile (Faxed) Copies................................................................................................................4Technical Assistance........................................................................................................................4Application Requirements and Format............................................................................................4Directions for Completing Application Form..................................................................................5

A. Title Page..............................................................................................................................5B. Youth Service Bureau Profile...............................................................................................6C. Administrative Core Unit Strategies and Activities..............................................................6D. Direct Services Unit Strategies and Activities......................................................................7E. Advisory Board Composition Report...................................................................................9F. Impact of Services: Professional Development Work Plans..............................................10G. Grant and Local Match Budget...........................................................................................10H. Budget Narrative.................................................................................................................11I. Annie E. Casey Foundation................................................................................................12J. Statutory Requirement of Administrative Core Unit Functions.........................................12

Appendices.....................................................................................................................................13A. Application..........................................................................................................................14B. List of Youth Service Bureaus Eligible for State Grants....................................................27C. List of Towns/Youth-Servicing Agencies and CSDE Codes.............................................28D. Youth Service Bureau Laws and Regulations....................................................................30E. Certification that a Current Affirmative Action Packet is on File......................................32F. Youth Service Bureau Results Based Accountability Sample Strategies and Activities....33G. Statutory Requirement of Administrative Core Unit Functions.........................................36H. Statement of Assurances.....................................................................................................37


Purpose and General Information

The purpose of the Youth Service Bureaus (YSBs) Grant Program is to assist municipalities and private youth-serving organizations designated to act as agents for municipalities in establishing, maintaining or expanding such YSBs. See Connecticut General Statutes (C.G.S.), Section 10-19n.

Overview

Local communities began to develop YSBs in the 1960’s as a response to a growing number of issues affecting youth. The role of the YSBs has been expanded to include both advocacy and coordination of a comprehensive service delivery system for youth. YSBs are organized to provide:

1. Administrative services, including an assessment of youth needs and the coordination of services for youth.

2. Direct services for youth that may include: recreational activities; individual and group counseling; parent training and family therapy; work placement and employment counseling; alternative and special educational opportunities; outreach programs; teen pregnancy services; suspension/expulsion services; diversion from juvenile justice services; preventive programs including youth pregnancy, youth suicide, violence, alcohol

and drug prevention; and programs that develop positive youth involvement.

3. Administrative core unit functions which include: general administration; research; resource development; community involvement; and youth advocacy.

Additionally, each YSB is required to have an advisory board responsible for making recommendations on overall policy and program direction of the YSB.

The number of YSBs participating in the grant program has increased from 56 YSBs serving 71 towns in 1979-80 to 101 bureaus serving 145 towns in 2014-15. State funding for the grant program has increased from $900,000 in 1979-80 to a high of $3.3 million in 1994-95. The program was funded at $2,929,483 in 2014-15.

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Who May Apply?

Connecticut General Statutes (C.G.S.) Section 10-19o, (formerly Sec. 17a-40a) provides that:

“Only Youth Service Bureaus which were eligible to receive grants pursuant to this Section for the fiscal year ending June 30, 2007, or which applied for a grant by June 30, 2012, with prior approval of the town’s contribution pursuant to subsection (b) of this Section, shall be eligible for a grant pursuant to this Section for any fiscal year commencing on or after July 1, 2012.”

There are 106 eligible YSBs. The list of eligible towns and designated private youth-serving agencies is included in Appendix B.

Grant Award PeriodThe grant award is for the two-year period July 1, 2015 through June 30, 2017. Each grantee must submit an annual budget for approval by CSDE. Funding is contingent on the amount of YSB funds available in the state budget each year.

Available Funds and Local Match Requirements

The Connecticut General Assembly appropriated $2,929,483 for the YSBs Grant Program for fiscal years 2014 and 2015. Ninety-eight percent of these funds were distributed to the eligible YSBs and towns. Each YSB is eligible for a minimum grant of $14,000. YSBs that received a grant in excess of $15,000 in 1994-95 are eligible for a proportionate share of the remaining appropriation. Additionally, each town must contribute an amount equal to the amount of the state grant, of which no less than 50 percent of the contribution shall be from funds appropriated by the town. The remaining amount may be matched with other funds or in-kind services. Grant funding will be awarded after the state budget is finalized.

Required Program Evaluation, Data Collection and Professional Development ActivitiesGrantees must:

1. Participate in the monitoring process, which is a requirement for all new YSB directors. Participants are required to attend all the training sessions.

2. Participate in quarterly meetings, during which the CSDE will facilitate a review of the progress on the new reporting system and performance measures, to ensure the new system and measures are meeting the needs of the grantees, and that children and youth are better off as a result of these accountability efforts.

3. Report annually in a format and submitting by the due date determined by the Commissioner of Education regarding the referral or diversion of children and youth from the juvenile justice system, as well as the provision of opportunities for all youth to function as responsible members of their communities.

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Pursuant to Section 10-19m-2 of the Regulations of Connecticut State Agencies, a YSB is required to assess the needs of youth, the availability of services and resources, and development and maintenance of data, in a manner satisfactory to the CSDE, that is necessary to determine and evaluate the impact of its administrative and services delivery programs. When a YSB collects student data, a consent form executed by the parent or guardian is required. The consent form must contain a statement addressing confidentiality of the information collected.

Certain student data collected by a YSB shall be forwarded to the CSDE. Any student information received by the CSDE, an educational agency under the Family Educational Rights Privacy Act (FERPA), becomes an educational record maintained pursuant to FERPA, which restricts disclosure of educational records. The information forwarded by a YSB to the CSDE shall include student name, date of birth, school district and school attending.

Deadline and Use of Application Form

The application, IRRESPECTIVE OF POSTMARK DATE AND MEANS OF TRANSMITTAL, must be received by 4:30 p.m. on June 15, 2015 . EXTENSIONS SHALL NOT BE GIVEN. Applications received past the deadline will be returned. Applications may be mailed or hand delivered to:

Mail/Deliver: Agnes Quiñones, Ed. D., Program ManagerConnecticut State Department of EducationBureau of Health/Nutrition, Family Services and Adult Education25 Industrial Park RoadMiddletown, CT 06457

Potential grantees will be required to submit a completed application. The enclosed application form shall be used. Modifications will not be accepted.

Affirmative Action AssurancesIn accordance with the regulations established by the Connecticut Commission on Human Rights and Opportunities (CCHRO), each applicant is required to have a completed/current Affirmative Action Packet on file with the CSDE, or must complete the Affirmative Action Packet by accessing the link (http://www.ct.gov/chro/lib/chro/pdf/notificationtobidders.pdf) and submit it with this document (Appendix E).

Additional Obligations of Grantee

All grantees are hereby notified that the grant to be awarded is subject to contract compliance requirements as set forth in C.G.S. Sections 4a-60 and 4a-60a and Sections 4a-68j et seq. of the Regulations of Connecticut State Agencies (RCSA). Furthermore, the grantee must submit periodic reports of its employment and subcontracting practices in such form, in such manner and in such time as may be prescribed by the CCHRO.

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http://www.ct.gov/chro/lib/chro/pdf/notificationtobidders.pdf


Due Dates and Ongoing Reporting

It is the responsibility of all grantees to complete all requirements in the timeframe determined by the CSDE. YSBs are required to submit a final report of the data collection by September 8, 2016, for fiscal year 2015-16 and by September 6, 2017, for fiscal year 2016-17 for each fiscal year. Reports submitted after the established deadline will not be accepted and could affect funds disbursement. Please note that the data collected in the reports due to the CSDE will be used to update a Results Based Accountability (RBA) report for the Connecticut General Assembly.

Freedom of Information Act

All of the information provided in a proposal submitted in response to this application for funds is subject to the provisions of the Freedom of Information Act Sections 1-200 et seq., (FOIA). The FOIA declares that except as provided by federal law or state statute, records maintained or kept on file by any public agency (as defined in the statute) are public records and every person has the right to inspect such records and receive a copy of such records.

Management Control of the Program and Grant Consultation Role of CSDE Personnel

The grantee must have complete management control of this grant. While CSDE staff may be consulted for their expertise, they will not be directly responsible for the selection of sub-grantees or vendors, nor will they be directly involved in the expenditure and payment of funds.

Annie E. Casey FoundationApplicants that are part of a collaborative effort funded in whole, or in part, by the Annie E. Casey Foundation must submit documentation to that effect (Section I of the Application Requirements).

Facsimile (Faxed) Copies

Facsimile (faxed) copies of proposals/applications will not be accepted.

Technical AssistanceThe program manager will be available at 860-807-2126 to answer questions regarding the Request for Proposal application procedures or format.

Application Requirements and Format

The application must contain the following components as described below: (NOTE: Appendix A provides the application form for program description and budget information.)A. Title PageB. Youth Service Bureau (YSB) Profile (with signature)C. Administrative Core Unit (ACU) Strategies and Activities D. Direct Services Unit (DSU) Strategies and ActivitiesE. Advisory Board Composition ReportF. Impact of Services: Work Plans G. Budget Forms

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H. Budget NarrativeI. Annie E. Casey FoundationJ. Statutory Requirement of Administrative Core Unit Functions

Directions for Completing Application Form

This Section provides directions for completing Appendix A, Application Form for the YSB Grant.

A. Title Page

Line 1. Legal Name of Organization For town-based YSBs, report the name of the town that is fiscally responsible for the YSB. For private youth-serving organizations designated to act as agents for one or more towns, report the legal name of the organization. The CSDE codes can be found in Appendix C.

Line 2. Federal Identification Number Town-based YSBs may leave this line blank. Private youth-serving organizations should report their federal identification number in this line.

Line 3. Town(s) to be Served Town-based YSBs serving a single town should repeat the town name reported on Line 1. YSBs serving more than one town should report all of the towns they serve here.

Line 4. Program Name Report the formal or legal name of the YSB.

Line 5. Executive Director Report the name, phone and fax numbers of the chief executive officer of the YSB.

Line 6. Contact Persons Report the name(s), phone and fax number(s) of the person(s) we should contact with questions and concerns about the YSB program, grant application and annual reports.

Line 7. Program Mailing Address Report the mailing address for all correspondence concerning the YSB grant.

Line 8. Program Location Address Report the location of the main business office of the YSB.

Line 9. YSB Director’s Signature The grant application should be signed by the director of the YSB, or if there is no director, by the chief municipal official of the town. Report the date the grant application is signed.

Line 10. Typed Name Report the full name and title of the person signing on Line 9.

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B. Youth Service Bureau Profile

Line 11. Demographic Information A. Enter the name of the YSB.B. Indicate whether the YSB is a municipal department or a nonprofit organization

(check one).C. If the YSB is municipality-based, indicate whether the YSB operates as an

independent department or grouped under a larger umbrella structure (check one). If part of a larger structure, enter the name of the department.

D. Enter the town(s) served by the YSB.E. Enter the total population of the town and the percent of population under age

18. You can find the information from the town census.Line 12. Funding

A. Enter the amount of money received from the CSDE for the YSB Grant.B. Enter the total amount of funds received from the municipality. If part of a

larger department, enter the amount earmarked for YSB functions.C. Enter the total amount of funds received from additional state and federal

grants.D. Enter the total amount of funds received from private grants and foundations.E. Enter the total amount of funds received from donations in FY 2015.F. Enter the total amount of funds received from fundraising.

i. Total lines A through F for total YSB funding. ii. Provide an estimate of the value of any in-kind services received.

Line 13. Staffing A. Provide information on the director of the YSB. Indicate whether the position is

full-time or part-time and union or non-union.B. Provide information on all additional YSB Bureau staff.

Line 14. Programming A. Place a check next to any of the programs listed that are offered by your YSB.

Requests have been received for data about the following programs. This is notintended to be a comprehensive list.

C. Administrative Core Unit Strategies and ActivitiesSummarize the proposed strategies and activities of your Administrative Core Unit. Group your strategies and activities under the following headings (only one strategy per core unit). Examples include:

Management and Administration – staff recruitment; staff supervision; staff evaluation and development; staff morale and burn-out prevention; filing and implementation regulations; monitoring of subcontractors; maintenance of organizational structure; financial management; casework and clinical supervision; management and information services; board management; marketing; facility management; policy development; strategic planning and development; program development; and decision making.

Youth Advocacy – voice for youth and youth issues; media relations; speaking at public hearings; contacts with local and state officials; state funding; letter writing; endorsing/creating legislation; networking; proactive trend awareness of youth issues;

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increasing community awareness of youth needs; and Youth Advisory Board mobilization for advocacy and participation in local, regional and state meetings.

Resource Development – networking; providing information; fundraising; program development; knowledge of and working with foundations; providing technical assistance; providing consulting to other groups; state funding; professional development; and state and national awareness.

Community Involvement – volunteer recruitment; running meetings; statewide networking; regional networking; gaining entry into systems; community organization and outreach; board and task force involvement; empowering community organizations; and Youth Advisory Board and promoting youth involvement.

Research and Evaluation – needs identification and assessment; program evaluation; grant writing; program selection; library/resource file; statistical analysis; college/ university interface; program development; and asset identification/mapping and investigating research models.

D. Direct Services Unit Strategies and Activities

Summarize the proposed strategies, programs and tasks of the direct services unit. If subcontractors are used, denote that the services are to be provided by a subcontractor. Group strategies and programs under the following headings. Note: There may not be strategies and programs for some of these headings. Indicate in the narrative and the tables on pages 19 and 20 if there is no programming in certain areas.

Juvenile Justice

Services that respond to youth who are, or could potentially be, in contact with the juvenile justice system.

Examples include: juvenile review boards; alternative sanction programs; detention/suspension/expulsion programs; court advocacy; court-ordered community-service programs; truancy programs; and diversion programs.

Mental Health Services

Services that respond to youth and families who are experiencing emotional distress.

A. Sessions for youth up to age 18B. Parent/Guardian Sessions

NOTE:1. Services noted under A. Children and Youth Sessions reported on both the

Individual Service Report and the Group Service Report.2. Services noted under B. Parent/Family Sessions reported only on the Group

Services Report.Examples include: mental health counseling for individuals, families, or groups; crisis intervention; host homes; information and referral services; and case management.

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Teen Pregnancy PreventionPrograms that promote pregnancy prevention among young people.

Teen Parent Education

Services that promote positive parenting skills and support families in their efforts to raise healthy children:

A. TeensB. Adults

NOTE:1. services noted under A. Teens are reported on both the Individual Service

report and the Group Service Report; and2. Services noted under B. Adults are reported only on the Group Services

Report.

Examples include; parent-child interactive playgroups, parent education and parent support groups.

Positive Youth Development

Programs and services that promote the personal well-being of youth for the purposes of:

A. meeting basic needs;

B. building skills and competencies that allow youth to function and contribute in their daily lives; and

C. connecting youth with their families, peers, schools and communities.

Examples include: peer-to-peer programs; employment training; mentoring; after-school programming; teen centers; dances; adventure based activities; youth adult partnership programs; information dissemination; and prevention programs that address issues such as truancy, violence and substance abuse and drug free alternative activities.

Community Outreach

Services and activities that support children and youth and strengthen families by reconnecting people of all generations and backgrounds to the community in which they live. This leads to the building of a sense of connectedness and empowerment to bring about positive social change. These are usually one-time events.

Examples include: intergenerational activities; family events; annual events/holiday festivals; sports; dances; family day celebrations; trips; theatrical productions; and cultural activities.

NOTE: Due to the nature of these activities, it may be extremely difficult to collect data for the Individual Service Reports. If this is the case, participants should be recorded as a potentially duplicated number on the Annual Group Services Report under Category B: Collaborations.For example: a family day celebration with 5,000 participants is reported as a Community

Outreach Collaboration on the Group Service Report;8


an intergenerational dinner including 20 youth and 100 senior citizens:- report the 100 seniors on the Group Services Report;- report the 20 youth on the Individual Service Report, if the structure of the

activity promotes positive youth development; or- if the youth are only involved in the event for recreational/social purposes,

then include them with the 100 seniors listed on the Annual Group Services Report.

NOTE: You are not likely to have program information that fits the Community Outreach Direct Service category.

E. Advisory Board Composition Report

A separate section on the Advisory Board must be submitted with the application. Please refer to page 21 for the Board Composition Criteria. This separate section must address the following components:1. Board Composition

a. board members need to be identified by category;b. vacant positions on the Board should be identified and described (Item 3

below); andc. YSBs serving multiple municipalities need to further identify which town

each member represents.

2. Board TypeBoard types are described as follows:a. Advisory Board: Refers to a Board specifically set up or structured in

conjunction with YSB whose sole mission is to serve in an advisory capacity to the YSB;

b. Youth Commission: Refers to a Commission established by municipal charter which may or may not have been set up in conjunction with YSB but which serves as an Advisory Board to the YSB; and

c. Other: Refers to any group other than an Advisory Board or Youth Commission serving as an Advisory Board to the YSB (Example: A Board of Directors).

3. Vacancies and WaiversIf the Advisory Board has vacancies among its members or if the Board is unable to appoint certain representatives, the Board does not meet the required size or composition criteria defined in the regulations. A waiver of the requirement(s) may be requested, as well as requesting an extension of time to fill vacancies, but in all cases, the Board’s circumstances are to be described in Item 3.

a. Full Waiver A full waiver of the Advisory Board requirements may be granted only where: (1) a YSB has a commission established by municipal charter, or (2) a YSB has a board of directors established by the by-laws of a private organization acting under contract with a municipality, provided that comparable citizen representation is present. A separate written request for a full waiver must be made by the chief municipal official.

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b. Partial WaiverA partial waiver may be granted for a Board’s size and composition only when the required agencies enumerated in the regulations do not exist in the town or when the regulatory requirements violate a municipal charter (example; town does not maintain a police department). A separate written request for a partial waiver must be made by the executive director of the YSB.

c. Extension of TimeAn extension of time may be granted for an Advisory Board to recruit and fill temporary vacancies among its members. Specific vacancies need to be identified along with a request for a reasonable length of time in Item 3 of this page of the grant application.

4. Board MeetingsPlease complete Items 4a and 4b.

F. Impact of Services: Professional Development Work Plans

A separate section of the Work Plan must be submitted with the application addressing the following components:

1. Goal: Indicate general intention for your program. Your goal should coincide with your Administrative Core Unit activities and Direct Service narrative.

2. Objective(s): Indicate what you hope to accomplish with the activity or activities.3. Activities: Indicate the planned activities that support your Goals and Objectives.4. Timetable: Indicate the month(s) the activities will take place.5. Measure of Success: (a) Indicate the measure or tool you will use; and (b) based on

that measure, indicate the benchmark by which you will determine whether you have successfully achieved the objective.

6. Population to be served: Indicate how many children you expect to serve, the age range and whether you are targeting a particular group of children.

7. Staff Assigned: Indicate the number of staff involved and their positions (example; outreach workers, tutors and counselors). Do not give names, just positions/job titles.

G. Grant and Local Match Budget

This is the budget specifically for this state grant. Report only the YSB grant funds and required matching funds. The match requirements are provided in Connecticut General Statutes Section 10-19o (b) and related Administrative Core Unit (ACU) and Direct Services Unit (DSU) budgets. Specific instructions for the Grant and Local Match Budget are as follows:

1. Enter YSB name and CSDE code.2. Enter budget amounts in the appropriate expense line and column. Include

expenses that apply to both the ACU and DSU (example; salaries and employee benefits. Only employee benefits that apply to positions funded by the grant or local match may be included). (indirect costs are NOT allowed)

a. CSDE Grant Award Column: enter the grant amounts on appropriate line items.

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b. Cash Match Column: Enter the amount of cash match on appropriate line items. Sources of the cash match may be municipal appropriation or other local funds such as service fees, fundraising, United Way funds, etc. State and federal grants may not be used.

c. In-Kind Match Column: Enter the amount of in-kind services on appropriate line items.

3. Total all columns and rows. Check that the total of the rows equals the total of the columns.

4. Complete the Grant/Match Summary (this summary provides totals for each column listed).

5. The certification statement shall be signed by either the executive director of the YSB, or, if there is no executive director, the chief municipal official of the town.

H. Budget Narrative

Budget Narrative: IncomeEnter YSB name and CSDE code. Provide a detailed description of the sources, amounts of funds and in-kind services to be used for the local match. Each item should agree with the corresponding income item in the Grant/Match Summary section of the “Grant and Local Match Budget.”

IncomeThe following income accounts are applicable to YSBs. These are similar to those used in previous years.

Youth Service Bureau GrantFunds from the CSDE YSB Grant program.

Other State FundsGrants or other funds from the State of Connecticut, not including the YSB Grant.

Federal FundsGrants or other funds from the federal government.

Municipal AppropriationThe amount appropriated to the YSB by some other organization or agency at no cost to the YSB. This appropriation should appear as a line item or functional description in the town budget(s).

In-Kind ServicesIn-kind services are supplied to the YSB by some other organization or agency at no cost to the YSB. The YSB may report the value of these services as income and expense. In-kind services include allocation of the projected actual costs of office space or other necessary space, utilities, heat, telephone, copying, consumable supplies, equipment maintenance, travel, and governmental administrative personnel or central office private agency personnel staff, who spend 50 percent or more of their time performing the administrative functions of the YSB. If these expenditures are not line items in the YSB’s budget, the value of volunteer services shall not be included as an in-kind service.

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Other IncomeOther income sources, such as service fees, fundraising, United Way funds, etc.

Budget Narrative: ExpensesEnter YSB name and CSDE code. Provide a detailed description of the expenses to be funded by the YSB grant funds and required local match for each expense account. Use additional copies of the expense sheet as necessary. Total each line item; each total should agree with the corresponding total expense on the Grant and Local Match Summary. Include details of all calculations and allocations.

I. Annie E. Casey Foundation

Applicants that are part of a collaborative effort funded in whole or in part by the Annie E. Casey Foundation must submit documentation under the following headings:

1. Collaborative OversightThe collaborative oversight entity has been provided the opportunity to review and comment on the grant application or proposal prior to submission to the CSDE.

2. ActivitiesThe proposal or application submitted provides information detailing the activities, which assure priority access to services to children, youth and families referred by the collaborative oversight entity.

3. LiaisonThe applicant shall designate someone to act as liaison for the referral process.

J. Statutory Requirement of Administrative Core Unit FunctionsComplete the Statement of Statutory Requirement of ACU Functions (Appendix G).

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Appendices

Appendix A: Application

Appendix B: List of Youth Service Bureaus Eligible for State Grants

Appendix C: List of Towns/Youth Serving Agencies and CSDE Codes

Appendix D: Youth Service Bureau Laws and Regulations

Appendix E: Certification that a Current Affirmative Action Packet is on File

Appendix F: Youth Service Bureau RBA Sample Strategies and Activities

Appendix G: Statutory Requirement of Administrative Core Unit Functions

Appendix H: Statement of Assurances

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APPENDIX AApplication

Youth Service Bureau Connecticut StateGrant Application #120 Department of EducationRevised May 2015Statutory Ref.: C.G.S. 10-19m through 10-19o

TITLE PAGE

1. Legal Name of Organization Applying for Funds:

CSDE Code:

2. Federal Identification No.:

3. Town(s) to be Served:

4. Program Name:

5. Executive Director: Phone: Fax:

Executive Director E-mail address:

6. Contact Persons:

Program: Phone: Fax:

Program Director E-mail address:

Fiscal: Phone: Fax:

Fiscal Director E-mail address:

7. Program Mailing Address:

8. Program Location Address:

I certify that the information submitted is in conformance with the instructions and is an accurate representation of the YSBs planned programs and services for the period July 1, 2015 through June 30, 2017. A new form will be submitted if changes occurred.

9. Authorized Signature: Date: __________


10. Typed Name: ________________________________________________ Title: __________

14YOUTH SERVICE BUREAU PROFILE

11. Demographic Information:A. Name of YSB:

B. Is the YSB a department of the municipality or a nonprofit organization C. If municipal-based, is the YSB an independent department or a department within a

larger department, such as social services or human services Name or Department:

D. Towns Served by YSB: E. Town Population: ___________________ Percentage of population under age 18:

12. Funding:A. YSB Grant (CSDE): B. Municipal Funds: C. Other State/Federal Grants: D. Private grants and foundations: E. Donations: F. Fundraising:

Total YSB Cash Annual Budget (A+B+C+D+E+F):

Estimated Value of In-Kind Services:

13. Staffing:A. YSB Director: Phone:

Email address: Is the Director: full-time or part-time

union or nonunion List the salary range for the Executive Director position:

B. Additional Staff:Number of additional full-time staff:

Number that are union:

Number that are nonunion:

Number of additional part-time staff: Number that are union:


Number that are nonunion:

Number of contracted personnel:

14. Programming:A. Please place a checkmark next to each of the following programs offered by your YSB.

after-school programming: for elementary-age youth for middle school-age youth for high school-age youth

Birth-Five parent/child programming (playgroups/support groups)

15 Counseling Services: Are clinicians: hired or contracted

hourly rate or daily rate Individual Counseling Group Counseling Parent Training Family Therapy

Work Placement and Employment Counseling Alternative and Special Educational Opportunities Recreational and Youth Enrichment Programs Outreach Programs Preventive Programs (including youth pregnancy, youth suicide, violence, and

alcohol and drug prevention) Positive Youth Development Programs Court Ordered Community Service Detention/Suspension/Expulsion Programs Juvenile Review Board Teen Center/Drop-In Center: after school evenings weekends Other Juvenile Justice Programs (please list):____________________________


16ADMINISTRATIVE CORE UNIT STRATEGIES AND PROGRAMS

The YSBs of Connecticut adopted and implemented a RBA framework, designed to guide the programs administered and the strategies used to ensure success.

Summarize the proposed strategies and activities of the administrative core unit using the following format:

a. Management and Administration – list one strategy and the activities necessary to enhance your operations. List measures you will use to determine how well you have done the activities and whether you have been successful. Group your strategies, activities and measures under the following headings (see sample in Appendix F).

Strategy Activities Measures

b. Youth Advocacy – list one strategy and the activities necessary to increase your youth advocacy. List measures you will use to determine how well you have done the activities and whether you have been successful.



c. Resource Development – list one strategy and the activities necessary to increase resources for your agency. List measures you will use to determine how well you have done the activities and whether you have been successful.


17d. Community Involvement – list one strategy and the activities necessary to increase

community involvement. List measures you will use to determine how well you have done the activities and whether you have been successful.


e. Research and Evaluation – list one strategy and the activities necessary to contribute to research. List measures you will use to determine how well you have done the activities and whether you have been successful.



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18DIRECT SERVICES UNIT STRATEGIES AND ACTIVITIES NARRATIVE

Summarize the proposed strategies and activities of your direct service unit. If you have subcontracted, note services provided by the subcontractor. Group your strategies, activities and measures under the following headings (see sample in Appendix F).

1. Juvenile Justice – list one strategy and the activities necessary to address the juvenile justice area. List measures you will use to determine how well you have done and whether you have been successful.


2. Mental Health Services – list one strategy and the activities necessary to provide mental health Services. List measures you will use to determine how well you have done the activities and whether you have been successful.


3. Child Welfare – list one strategy and the activities necessary to promote child welfare. List measures you will use to determine how well you have done the activities and whether you have been successful.



a. Teen Pregnancy Prevention – list one strategy and the activities necessary to prevent teen pregnancy. List measures you will use to determine how well you have done the activities and whether you have been successful.


19b. Teen Parent Education – list one strategy and the activities necessary to educate teen

parents. List the measures you will use to determine how well you have done the activities and whether you have been successful.


c. Positive Youth Development – list one strategy and the activities necessary to promote positive youth development. List measures you will use to determine how well you have done the activities and whether you have been successful.


4. Community Outreach – list one strategy and the activities necessary to improve community outreach. List measures you will use to determine how well you have done the activities and whether you have been successful.



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Advisory Board Composition Report

1. Board CompositionAttach a current membership list of your Advisory Board or Youth Commission to the grant application. The list should include at least the following information for each Board member: Name plus Member Type:

Youth School System representative Police Department representative Private youth serving agency representative Service consumer

Where a YSB serves more than one municipality, the membership list should also indicate that the Board includes a duly appointed representative from each municipality served.

2. Board TypeCheck the appropriate board type for your Advisory Board. Advisory Youth Commission Other – please specify

3. Vacancies and WaiversIf your Advisory Board does not meet the composition criteria (see box above), please describe the circumstances below and refer to the instructions for information on requests for waivers and extensions:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Anticipated date for meeting composition criteria: __________________________________

Composition Criteria At least seven members. At least one member under 21-years-of-age (nonvoting member). Representatives from the school system, police department and a private youth-serving

agency. At least one-third of the total membership from individuals who receive less than 50 percent

of their income from delivering services to youth. At least one member on the Board from each municipality served by the YSB.


4. Board Meetings(a) The number of times the YSB Advisory Board meets each fiscal year?

(b) Are minutes of all meetings on file in your office and available for inspection? Yes / No

21Impact of Services: Professional Development Work Plan

List a minimum of three professional development activities in which you will participate in 2015-17. (Please refer to page 10, letter F for guidelines.)

Required Professional Development Activities Impacted Administrative Core Unit (ACU) Function

1. Results Based Accountability (RBA)

2. Proposed Professional Development

3. Proposed Professional Development


22ED114 FISCAL YEAR 2016 YOUTH SERVICE BUREAU BUDGET FORM

GRANT TITLE: YOUTH SERVICE BUREAU PROJECT TITLE: CORE-CT CLASSIFICATION: FUND: 11000 SPID: 17052 PROGRAM: 82079 BUDGET REFERENCE: 2016

CHARTFIELD1: 170002 CHARTFIELD2:

GRANT PERIOD: 07/01/15- 06/30/16 AUTHORIZED AMOUNT:$

AUTHORIZED AMOUNT by SOURCE: CURRENT DUE:$ LOCAL BALANCE:$ CARRY-OVER DUE:$

CODES DESCRIPTIONS BUDGET AMOUNT CASH MATCH IN-KIND

111A NON-INSTRUCTIONAL200 PERSONAL SERVICES/EMPLOYEE BENEFITS300 PURCHASES PROFESSIONAL/TECHNICAL SVCS400 PURCHASED PROPERTY SERVICES500 OTHER PURCHASED SERVICES600 SUPPLIES700 PROPERTY800 DEBT SERVICE AND MISELLANEOUS

TOTAL

ORIGINAL REQUEST DATE ___ CT STATE DEPARTMENT OF EDUCATION DATE OF

REVISED REQUEST DATE PROGRAM MANAGER AUTHORIZATION APPROVAL

Grant/Match SummaryCSDE Grant AwardLocal Match:

Municipal AppropriationOther FundsIn-Kind

Total Local Match

I certify that the budget provided herein represents the planned income and expenditures of the YSB Grant funds and local match of the above grantee for the grant period July 1, 2015 through June 30, 2016, in accordance with all applicable instructions and statutory requirements.


Authorized Signature Date

Typed Signature Date

23Budget Object CodesInclude all budget account descriptions for the following categories:

111A Non-InstructionalAmounts paid to administrative employees of the grantee not involved in providing direct services to pupils/clients. Include all gross salary payments for these individuals while they are on the grantee payroll including overtime salaries or salaries paid to employees of a temporary nature.

200 Personal Services - Employee BenefitsAmounts paid by the grantee on behalf of employees; these amounts are not included in the gross salary, but are in addition to that amount. Such payments are fringe benefit payments and, while not paid directly to employees, nevertheless are part of the cost of personal services.

300 Purchased Professional and Technical ServicesServices which, by their nature, can be performed only by persons or firms with specialized skills and knowledge. While a product may or may not result from the transaction, the primary reason for the purchase is the service provided. Included are the services of architects, engineers, auditors, dentists, medical doctors, lawyers, consultants, teachers, accountants, etc.

400 Purchased Property ServicesServices purchased to operate, repair, maintain, and rent property owned or used by the grantee. These services are performed by persons other than grantee employees. While a product may or may not result from the transaction, the primary reason for the purchase is the service provided.

500 Other Purchased ServicesAmounts paid for services rendered by organizations or personnel not on the payroll of the grantee (separate from Professional and Technical Services or Property Services). While a product may or may not result from the transaction, the primary reason for the purchase is the service provided.

600 SuppliesAmounts paid for items that are consumed, worn out or deteriorated through use, or items that lose their identity through fabrication or incorporation into different or more complex units or substances.


700 PropertyExpenditures for acquiring fixed assets, including land or existing buildings, improvements of grounds, initial equipment, additional equipment, and replacement of equipment.In accordance with the Connecticut State Comptroller’s definition equipment, included in this category are all items of equipment (machinery, tools, furniture, vehicles, apparatus, etc.) with a value of over $1,000.00 and the useful life of more than one year and data processing equipment that has unit price under $1,000.00 and a useful life of not less than five years.

800 Debt Service and MiscellaneousAmounts paid for goods and services not otherwise classified above.

24Budget Narrative – Income

Provide a detailed description of the sources and amounts of funds and in-kind services to be used for the local match. Line item totals should agree with line items on the Grant and Local Match Summary form.

Account Line ItemName Description Total

Funds from the CSDE YSB Grant Program

Other Funds(State and Federal)

List source and amounts for other funds that will be used as matching funds for this grant.

Municipal Appropriation

The portion of the amount appropriated to the YSB by the town(s) to be served that will be used as matching funds for this grant. List town(s):


Account Line ItemIn-Kind List source and amounts for in-kind contributions that

will be used as match for this grant.

25Budget Narrative – Expenses

Provide a detailed description of the expenses to be funded by the YSB grant funds and required local match for each expense account. Copy this form as necessary. Line item totals should agree with line items on the “Grant and Local Match Budget” form.

Account Line ItemCode/Name Description Total


Account Line Item

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APPENDIX BList of Youth Service Bureaus Eligible for State Grants

YSB Appendix B – State Grant Eligibility


ANSONIAASHFORDAVONBERLINBLOOMFIELDBRANFORDBRIDGEPORTBRISTOLCANAANCANTONCHESHIRECLINTONCOLCHESTERCOLUMBIACOVENTRYCROMWELLDANBURYDERBYDURHAMEAST GRANBYEAST HADDAMEAST HAMPTONEAST HARTFORDEAST HAVENEAST LYMEELLINGTONENFIELDESSEXFAIRFIELDFARMINGTONGLASTONBURYGRANBYGREENWICHGRISWOLDGROTONGUILFORDHAMDENHARTFORDHEBRONKILLINGWORTHLEDYARDMADISONMANCHESTERMANSFIELDMERIDENMIDDLETOWN

MILFORDMONTVILLENAUGATUCKNEW BRITAINNEW CANAANNEW HAVENNEWINGTONNEW LONDONNEW MILFORDNEWTOWNNORTH BRANFORDNORTH HAVENNORWALKNORWICHOLD LYMEOLD SAYBROOKORANGEPLAINFIELDPLAINVILLEPORTLANDPRESTONPROSPECTRIDGEFIELDROCKY HILLSHELTONSIMSBURYSOUTHINGTONSOUTH WINDSORSTAFFORDSTAMFORDSTONINGTONSTRATFORDSUFFIELDTHOMASTONTOLLANDTORRINGTONTRUMBULLVERNONVOLUNTOWNWALLINGFORDWATERFORDWATERTOWNWESTBROOKWEST HARTFORDWEST HAVENWESTON

WESTPORTWETHERSFIELDWILLINGTONWILTONWINCHESTERWINDHAMWINDSORWINDSOR LOCKSWOODBRIDGEWATERBURY YOUTH SERVICE SYSTEM, INC.

SOUTHBURY/ MIDDLEBURYNOROTON HEIGHTS

DEPOT

27

YSB Appendix B – State Grant Eligibility


APPENDIX CList of Towns/Youth-Servicing Agencies and CSDE Codes

CODE Town CODE Town

1 ANDOVER2 ANSONIA3 ASHFORD4 AVON5 BARKHAMSTED6 BEACON FALLS7 BERLIN8 BETHANY9 BETHEL10 BETHLEHEM11 BLOOMFIELD12 BOLTON13 BOZRAH14 BRANFORD15 BRIDGEPORT16 BRIDGEWATER17 BRISTOL18 BROOKFIELD19 BROOKLYN20 BURLINGTON21 CANAAN22 CANTERBURY23 CANTON24 CHAPLIN25 CHESHIRE26 CHESTER27 CLINTON28 COLCHESTER29 COLEBROOK30 COLUMBIA31 CORNWALL32 COVENTRY33 CROMWELL34 DANBURY35 DARIEN36 DEEP RIVER37 DERBY38 DURHAM39 EASTFORD40 EAST GRANBY41 EAST HADDAM42 EAST HAMPTON43 EAST HARTFORD44 EAST HAVEN45 EAST LYME46 EASTON47 EAST WINDSOR48 ELLINGTON49 ENFIELD50 ESSEX

51 FAIRFIELD52 FARMINGTON53 FRANKLIN54 GLASTONBURY55 GOSHEN56 GRANBY57 GREENWICH58 GRISWOLD59 GROTON60 GUILFORD61 HADDAM62 HAMDEN63 HAMPTON64 HARTFORD65 HARTLAND66 HARWINTON67 HEBRON68 KENT69 KILLINGLY70 KILLINGWORTH71 LEBANON72 LEDYARD73 LISBON74 LITCHFIELD75 LYME76 MADISON77 MANCHESTER78 MANSFIELD79 MARLBOROUGH80 MERIDEN81 MIDDLEBURY82 MIDDLEFIELD83 MIDDLETOWN84 MILFORD85 MONROE86 MONTVILLE87 MORRIS88 NAUGATUCK89 NEW BRITAIN90 NEW CANAAN91 NEW FAIRFIELD92 NEW HARTFORD93 NEW HAVEN94 NEWINGTON95 NEW LONDON96 NEW MILFORD97 NEWTOWN98 NORFOLK99 NORTH BRANFORD100 NORTH CANAAN

YSB Grant Application Appendix C – Town Names 28


APPENDIX C (cont.)

CODE Town101 NORTH HAVEN102 NORTH STONINGTON103 NORWALK104 NORWICH105 OLD LYME106 OLD SAYBROOK107 ORANGE108 OXFORD109 PLAINFIELD110 PLAINVILLE111 PLYMOUTH112 POMFRET113 PORTLAND114 PRESTON115 PROSPECT116 PUTNAM117 REDDING118 RIDGEFIELD119 ROCKY HILL120 ROXBURY121 SALEM122 SALISBURY123 SCOTLAND124 SEYMOUR125 SHARON126 SHELTON127 SHERMAN128 SIMSBURY129 SOMERS130 SOUTHBURY131 SOUTHINGTON132 SOUTH WINDSOR133 SPRAGUE134 STAFFORD135 STAMFORD136 STERLING137 STONINGTON138 STRATFORD139 SUFFIELD140 THOMASTON141 THOMPSON142 TOLLAND143 TORRINGTON144 TRUMBULL145 UNION146 VERNON147 VOLUNTOWN148 WALLINGFORD149 WARREN150 WASHINGTON151 WATERBURY

152 WATERFORD

CODE Town153 WATERTOWN154 WESTBROOK155 WEST HARTFORD156 WEST HAVEN157 WESTON158 WESTPORT159 WETHERSFIELD160 WILLINGTON161 WILTON162 WINCHESTER163 WINDHAM164 WINDSOR165 WINDSOR LOCKS166 WOLCOTT167 WOODBRIDGE168 WOODBURY169 WOODSTOCK630 UNITED WAY OF GREENWICH631 WATERBURY YOUTH

SERVICE SYSTEM INC.632 SOUTHBURY/MIDDLEBURY633 NOROTON HEIGHTS DEPOT

YSB Grant Application Appendix C – Town Names 28


APPENDIX DYouth Service Bureau Laws and Regulations

Sec. 10-19m. (Formerly Sec. 17a-39). Youth service bureaus. Annual report. Regulations. (a) For the purposes of this section, “youth” shall mean a person from birth to eighteen years of age. Any one or more municipalities or any one or more private youth serving organizations, designated to act as agents of one or more municipalities, may establish a multipurpose youth service bureau for the purposes of evaluation, planning, coordination and implementation of services, including prevention and intervention programs for delinquent, pre-delinquent, pregnant, parenting and troubled youth referred to such bureau by schools, police, juvenile courts, adult courts, local youth-serving agencies, parents and self-referrals. A youth service bureau shall be the coordinating unit of community-based services to provide comprehensive delivery of prevention, intervention, treatment and follow-up services. 3

(b) A youth service bureau established pursuant to subsection (a) of this section may provide, but shall not be limited to, the delivery of the following services: (1) individual and group counseling; (2) parent training and family therapy; (3) work placement and employment counseling; (4) alternative and special educational opportunities; (5) recreational and youth enrichment programs; (6) outreach programs to insure participation and planning by the entire community for the development of regional and community-based youth services; (7) preventive programs, including youth pregnancy, youth suicide, violence, alcohol and drug prevention; and (8) programs that develop positive youth involvement. Such services shall be designed to meet the needs of youth by the diversion of troubled youth from the justice system as well as by the provision of opportunities for all youth to function as responsible members of their communities. (c) The Commissioner of Education shall adopt regulations, in accordance with the provisions of chapter 54, establishing minimum standards for such youth service bureaus and the criteria for qualifying for state cost-sharing grants, including, but not limited to, allowable sources of funds covering the local share of the costs of operating such bureaus, acceptable in-kind contributions and application procedures. Said commissioner shall, on December 1, 1979, and annually thereafter, report to the General Assembly on the referral or diversion of children under the age of eighteen years from the juvenile justice system and the court system. Such report shall include, but not limited to, the number of times any child is so diverted, the number of children diverted, the ages of the children diverted and such other information and statistics as the General Assembly may request from time to time. Any such report shall contain no identifying information about any particular child.

*Please note that Section 78 of Public Act 07-04 of the June Special Session amended Subsection (c) of this so that effective January 1, 2010, Subsection (c) will read as follows:

Sec. 10-19n. (Formerly Sec. 17a-40). State aid for establishment and expansion of youth service bureaus. To assist municipalities and private youth-serving organizations designated to act as agents for such municipalities in establishing, maintaining or expanding such youth service bureaus, the state, acting through the Commissioner of Education, shall provide cost-sharing

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grants, subject to the provisions of this section for (1) the cost of an administrative core unit and (2) the cost of the direct services unit provided by such youth service bureau. No state grant shall be made for capital expenditures of such bureaus. All youth service bureaus shall submit a request for a grant, pursuant to this section and sections 10-19m and 10-19o, on or before May fifteenth of the fiscal year prior to the fiscal year for which such grant is requested.Sec. 10-19o. (Formerly Sec. 17a-40a). Youth service bureau grant program. (a) The Commissioner of Education shall establish a program to provide grants to youth service bureaus in accordance with this section. Only youth service bureaus which were eligible to receive grants pursuant to this section for the fiscal year ending June 30, 2007, or which applied for a grant by June 30, 2012, with prior approval of the town’s contribution pursuant to subsection (b) of this section, shall be eligible for a grant pursuant to this section for any fiscal year commencing on or after July 1, 2012. Each such youth service bureau shall receive a grant of fourteen thousand dollars. The Department of Education may expend an amount not to exceed two percent of the amount appropriated for purposes of this section for administrative expenses. If there are any remaining funds, each such youth service bureau that was awarded a grant in excess of fifteen thousand dollars in the fiscal year ending June 30, 1995, shall receive a percentage of such funds. The percentage shall be determined as follows: For each such grant in excess of fifteen thousand dollars, the difference between the amount of the grant awarded to the youth service bureau for the fiscal year ending June 30, 1995, and fifteen thousand dollars shall be divided by the difference between the total amount of the grants awarded to all youth service bureaus that were awarded grants in excess of fifteen thousand dollars for said fiscal year and the product of fifteen thousand dollars and the number of such grants for said fiscal year. (b) In order for a youth service bureau to receive the full amount of the state grant determined pursuant to subsection (a) of this section, a town shall contribute an amount equal to the amount of the state grant. A town shall provide not less than fifty per cent of its contribution from funds appropriated by the town for that purpose, and the remaining amount in other funds or in-kind contributions in accordance with regulations adopted by the State Board of Education in accordance with Chapter 54. (c) Any funds remaining due to a town’s failure to match funds as provided in subsection (b) of this section, shall be redistributed in accordance with the provisions of this section. The State Board of Education shall adopt regulations in accordance with the provisions of Chapter 54 to coordinate the youth service bureau program and to administer the grant system established pursuant to this section and sections 10-19m and 10-19n.

Sec. 10-19p. (Formerly Sec. 17a-41). Assistance to youth service bureaus. The Department of Education shall provide grant management services, program monitoring, program evaluation and technical assistance to such state-aided youth service bureaus, and the Commissioner may assign or appoint necessary personnel to perform such duties, subject to the provisions of Chapter 67.


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APPENDIX E

Certification that a Current Affirmative Action Packet is on File

I, the undersigned authorized official, hereby certify that the applying organization/ agency has a current affirmative action packet on file with the Connecticut State Department of Education. The Affirmative Action Packet is, by reference, part of this application.

Signature of Authorized Official: __________________________ Date: _____________

Name and Title:___________________________________________________________


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APPENDIX FYouth Service Bureau Results Based Accountability (RBA) Sample Strategies and Activities

Administrative Core Unit Strategies and Activities

Sample StrategiesSample Activities

Improve the administration of YSB programs and services. To evaluate administrative procedures.To streamline fiscal and data management procedures.To provide staff training and improve skills.

Identify the needs of youth and current service gaps. To develop youth forum concerning their needs and solutions.To survey the community regarding needs and services.To develop centralized data bank.

Increase the resources and services available to youth. To research available funding services.To write grant applications.

Inform the community of programs and services. To compile information on all community youth programs into a database.To develop and regularly update a resource guide.

Coordinate with local providers to eliminate service gaps and enhance the delivery of services.

To convene relevant community groups to plan activities.To write joint grant application with other providers.To initiate and maintain ongoing planning process with other community groups.

Advocate for the needs of all youth to improve policies and procedures.

To advocate for local policies and procedures that benefit youth.To keep community leaders aware of YSB functions.To advocate for individual youth.

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Administrative Core Unit Strategies and Activities (APPENDIX F cont.)

Sample StrategiesSample Activities

Improve the administration of YSB programs and services. Evaluate administrative procedures.Streamline fiscal and data management procedures.Provide staff training to improve skills.

Identify the needs of youth and current service gaps. To develop youth forum concerning their needs and solutions.To survey the community regarding needs and services.To develop centralized data bank.

Increase the resources and services available to youth. Research available funding services.Write grant applications.

Inform the community of programs and services. Compile information on all community youth programs into a database.Develop and plan for the regular updating of a resource guide.

Coordinate with local providers to eliminate service gaps and enhance the delivery of services.

Convene relevant community groups to produce an activity plan.Write joint grant application with other providers.Initiate and maintain ongoing planning process with other community groups.

Advocate for the needs of all youth to improve policies and procedures.

Advocate for local policies and procedures that benefit youth.Keep community leaders aware of YSB functions.Advocate for individual youth.

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Approved By Forms Review CommitteeRFP 120-051409

YOUTH SERVICE BUREAU GRANT PROGRAM


Direct Services Unit Strategies and Activities (APPENDIX F cont.)

Sample Strategies Sample Activities

Youth will have the special supports and services they need in times of personal or family crises and in times of difficult personal transition.

To divert youth from the juvenile justice system.To provide intervention service to identified ‘at-risk’ populations.To provide support services to ‘at-risk’ youth and their families.

Youth and families will understand their own needs, the needs of their family members and will understand how to generate a mutually supportive family environment.

To provide counseling / therapy to youth and their families.To provide sexual abuse counseling and support.To provide truancy prevention services to community youth.

Youth will have attitudes, work values and skills to obtain and hold jobs.

To maintain a job bank for youth.To provide career exploration support services to youth.

Youth will have strong bonds to their families, peers, schools and communities. Youth will contribute to the well-being and strength of their families, schools and communities.

To provide youth leadership training.To host discussion groups for youth to discuss issues of importance to them.

Educate on issues of importance to youth. To train youth as peer mentors. To provide education on sexual abuse.To provide education on well childcare.To provide substance abuse education.

Youth will participate in positive social, cultural and athletic activities in their leisure time.

To provide an alcohol and drug-free social environment for youth.To provide opportunities to participate in drama and sports.

Parents will have the knowledge and skills to guide their children so that they become responsible productive citizens.

To provide parent workshops.To provide educational materials related to children.

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APPENDIX GStatutory Requirement of Administrative Core Unit Functions

In my official capacity as signatory for the ____________________ Youth Service Bureau, I, the undersigned authorized official*, hereby recognize and support the statutory requirements and regulations of the Youth Service Bureau (C.G.S. Sections 10-19m through 10-19o) to provide the five Administrative Core Unit (ACU) functions of:

1. Management and Administration.

2. Research that provides for the continued assessment of community needs and assets.

3. Resource development.

4. Community involvement.

5. Advocacy on behalf of issues related to youth and families.

____________________________________ _______________________

Name Date

*Authorized official may be:

Department Head

Town Manager

First Selectman

Mayor

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APPENDIX HStatement of Assurances

STATEMENT OF ASSURANCES

CONNECTICUT STATE DEPARTMENT OF EDUCATIONSTANDARD STATEMENT OF ASSURANCES

GRANT PROGRAMS

PROJECT TITLE:

THE APPLICANT: HEREBY ASSURES THAT:

(insert Agency/School/CBO Name)

A. The applicant has the necessary legal authority to apply for and receive the proposed grant;

B. The filing of this application has been authorized by the applicant's governing body, and the undersigned official has been duly authorized to file this application for and on behalf of said applicant, and otherwise to act as the authorized representative of the applicant in connection with this application;

C. The activities and services for which assistance is sought under this grant will be administered by or under the supervision and control of the applicant;

D. The project will be operated in compliance with all applicable state and federal laws and in compliance with regulations and other policies and administrative directives of the State Board of Education and the Connecticut State Department of Education;

E. Grant funds shall not be used to supplant funds normally budgeted by the agency;

F. Fiscal control and accounting procedures will be used to ensure proper disbursement of all funds awarded;

G. The applicant will submit a final project report (within 60 days of the project completion) and such other reports, as specified, to the Connecticut State Department of Education, including information relating to the project records and access thereto as the Connecticut State Department of Education may find necessary;

H. The Connecticut State Department of Education reserves the exclusive right to use and grant the right to use and/or publish any part or parts of


any summary, abstract, reports, publications, records and materials resulting from this project and this grant;

I. If the project achieves the specified objectives, every reasonable effort will be made to continue the project and/or implement the results after the termination of state/federal funding;

37

J. The applicant will protect and save harmless the State Board of Education from financial loss and expense, including legal fees and costs, if any, arising out of any breach of the duties, in whole or part, described in the application for the grant;

K. At the conclusion of each grant period, the applicant will provide for an independent audit report acceptable to the grantor in accordance with Sections 7-394a and 7-396a of the Connecticut General Statutes, and the applicant shall return to the Connecticut State Department of Education any moneys not expended in accordance with the approved program/operation budget as determined by the audit;

L. REQUIRED LANGUAGE (NON-DISCRIMINATION)References in this section to “contract” shall mean this grant agreement and to “contractor” shall mean the Grantee.

(a) For purposes of this Section, the following terms are defined as follows:

i. "Commission" means the Commission on Human Rights and Opportunities;

ii. "Contract" and “contract” include any extension or modification of the Contract or contract;

iii. "Contractor" and “contractor” include any successors or assigns of the Contractor or contractor;

iv. "Gender identity or expression" means a person's gender-related identity, appearance or behavior, whether or not that gender-related identity, appearance or behavior is different from that traditionally associated with the person's physiology or assigned sex at birth, which gender-related identity can be shown by providing evidence including, but not limited to, medical history, care or treatment of the gender-related identity, consistent and uniform assertion of the gender-related identity or any other evidence that the gender-related identity is sincerely held, part of a person's core identity or not being asserted for an improper purpose;

v. “good faith" means that degree of diligence which a reasonable person would exercise in the performance of legal duties and obligations;

vi. "good faith efforts" shall include, but not be limited to, those reasonable initial efforts necessary to comply with statutory or regulatory requirements and additional or substituted efforts when


it is determined that such initial efforts will not be sufficient to comply with such requirements;

vii. "marital status" means being single, married as recognized by the state of Connecticut, widowed, separated or divorced;

viii. "mental disability" means one or more mental disorders, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders", or a record of or regarding a person as having one or more such disorders;

ix. "minority business enterprise" means any small contractor or supplier of materials fifty-one percent or more of the capital stock, if any, or assets of which is owned by a person or persons: (1) who are active in the daily affairs of the enterprise, (2) who have the power to direct the management and policies of the enterprise, and (3) who are members of a minority, as such term is defined in subsection (a) of Connecticut General Statutes § 32-9n; and

38

x. "public works contract" means any agreement between any individual, firm or corporation and the State or any political subdivision of the State other than a municipality for construction, rehabilitation, conversion, extension, demolition or repair of a public building, highway or other changes or improvements in real property, or which is financed in whole or in part by the State, including, but not limited to, matching expenditures, grants, loans, insurance or guarantees.

For purposes of this Section, the terms "Contract" and “contract” do not include a contract where each contractor is (1) a political subdivision of the state, including, but not limited to, a municipality, (2) a quasi-public agency, as defined in Conn. Gen. Stat. Section 1-120, (3) any other state, including but not limited to any federally recognized Indian tribal governments, as defined in Conn. Gen. Stat. Section 1-267, (4) the federal government, (5) a foreign government, or (6) an agency of a subdivision, agency, state or government described in the immediately preceding enumerated items (1), (2), (3), (4) or (5).

(b)(1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will not discriminate or permit discrimination against any person or group of persons on the grounds of race, color, religious creed, age, marital status, national origin, ancestry, sex, gender identity or expression, mental retardation, mental disability or physical disability, including, but not limited to, blindness, unless it is shown by such Contractor that such disability prevents performance of the work involved, in any manner prohibited by the laws of the United States or of the State of Connecticut; and the Contractor further agrees


to take affirmative action to insure that applicants with job-related qualifications are employed and that employees are treated when employed without regard to their race, color, religious creed, age, marital status, national origin, ancestry, sex, gender identity or expression, mental retardation, mental disability or physical disability, including, but not limited to, blindness, unless it is shown by the Contractor that such disability prevents performance of the work involved; (2) the Contractor agrees, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, to state that it is an "affirmative action-equal opportunity employer" in accordance with regulations adopted by the Commission; (3) the Contractor agrees to provide each labor union or representative of workers with which the Contractor has a collective bargaining Agreement or other contract or understanding and each vendor with which the Contractor has a contract or understanding, a notice to be provided by the Commission, advising the labor union or workers’ representative of the Contractor's commitments under this section and to post copies of the notice in conspicuous places available to employees and applicants for employment; (4) the Contractor agrees to comply with each provision of this Section and Connecticut General Statutes §§ 46a-68e and 46a-68f and with each regulation or relevant order issued by said Commission pursuant to Connecticut General Statutes §§ 46a-56, 46a-68e and 46a-68f; and (5) the Contractor agrees to provide the Commission on Human Rights and Opportunities with such information requested by the Commission, and permit access to pertinent books, records and accounts, concerning the employment practices and procedures of the Contractor as relate to the provisions of this Section and Connecticut General Statutes § 46a-56. If the contract is a public works contract, the Contractor agrees and warrants that he will make good faith efforts to employ minority business enterprises as subcontractors and suppliers of materials on such public works projects.

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(c) Determination of the Contractor's good faith efforts shall include, but shall not be limited to, the following factors: The Contractor's employment and subcontracting policies, patterns and practices; affirmative advertising, recruitment and training; technical assistance activities and such other reasonable activities or efforts as the Commission may prescribe that are designed to ensure the participation of minority business enterprises in public works projects.

(d)The Contractor shall develop and maintain adequate documentation, in a manner prescribed by the Commission, of its good faith efforts.

(e) The Contractor shall include the provisions of subsection (b) of this Section in every subcontract or purchase order entered into in order to fulfill any obligation of a contract with the State and such provisions shall be binding on a subcontractor, vendor or manufacturer unless


exempted by regulations or orders of the Commission. The Contractor shall take such action with respect to any such subcontract or purchase order as the Commission may direct as a means of enforcing such provisions including sanctions for noncompliance in accordance with Connecticut General Statutes §46a-56; provided if such Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the Commission, the Contractor may request the State of Connecticut to enter into any such litigation or negotiation prior thereto to protect the interests of the State and the State may so enter.

(f) The Contractor agrees to comply with the regulations referred to in this Section as they exist on the date of this Contract and as they may be adopted or amended from time to time during the term of this Contract and any amendments thereto.

(g)(1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will not discriminate or permit discrimination against any person or group of persons on the grounds of sexual orientation, in any manner prohibited by the laws of the United States or the State of Connecticut, and that employees are treated when employed without regard to their sexual orientation; (2) the Contractor agrees to provide each labor union or representative of workers with which such Contractor has a collective bargaining Agreement or other contract or understanding and each vendor with which such Contractor has a contract or understanding, a notice to be provided by the Commission on Human Rights and Opportunities advising the labor union or workers' representative of the Contractor's commitments under this section, and to post copies of the notice in conspicuous places available to employees and applicants for employment; (3) the Contractor agrees to comply with each provision of this section and with each regulation or relevant order issued by said Commission pursuant to Connecticut General Statutes § 46a-56; and (4) the Contractor agrees to provide the Commission on Human Rights and Opportunities with such information requested by the Commission, and permit access to pertinent books, records and accounts, concerning the employment practices and procedures of the Contractor which relate to the provisions of this Section and Connecticut General Statutes § 46a-56.

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(h) The Contractor shall include the provisions of the foregoing paragraph in every subcontract or purchase order entered into in order to fulfill any obligation of a contract with the State and such provisions shall be binding on a subcontractor, vendor or manufacturer unless exempted by regulations or orders of the Commission. The Contractor shall take such


action with respect to any such subcontract or purchase order as the Commission may direct as a means of enforcing such provisions including sanctions for noncompliance in accordance with Connecticut General Statutes § 46a-56; provided, if such Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the Commission, the Contractor may request the State of Connecticut to enter into any such litigation or negotiation prior thereto to protect the interests of the State and the State may so enter.

M.The grant award is subject to approval of the Connecticut State Department of Education and availability of state or federal funds.

N. The applicant agrees and warrants that Sections 4-190 to 4-197, inclusive, of the Connecticut General Statutes concerning the Personal Data Act and Sections 10-4-8 to 10-4-10, inclusive, of the Regulations of Connecticut State Agencies promulgated there under are hereby incorporated by reference.

I, the undersigned authorized official; hereby certify that these assurances shall be fully implemented.

Signature:

Name: (typed)

Title: (typed)

Date:

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